The goal of this 4-year qualitative study is to describe and examine how dying and death are approached and understood by health professionals, patients, and families; and to examine how dying and death occur among older adults in one community hospital. This will be an empirical, ethnographic investigation based on the collection of data by interviews with physicians, nurses, patients, and families and by participant-observation at formal and informal health care team meetings on seven units in the hospital setting. The study has five specific aims: 1) to provide a descriptive account of hospital deaths among older persons and reactions to them; 2) to learn what dying means to the dying person and how it is defined and understood by others; 3) to investigate the knowledge and values through which physicians, nurses, patients, and families make treatment decisions; 4) to discover how and the extent to which assumptions about dying and hospital practices surrounding death are mediated by age; and 5) to investigate how decisions about dying are influenced by policies governing payment and liability, and by legal prerogatives that control consent, advance directives, and surrogate decision-making. Coding-based qualitative data analysis will be used. Three distinct approaches of this technique will be employed for the analysis of both interview material and fieldnotes generated from participant- observation: 1) cross-sectional comparison, in order to describe discrete patterns of thought, opinion, and practice, and the variations therein; 2) thematic analysis and the case study approach, to identify themes that emerge within a specific case; and 3) frequencies of response, in which frequencies of themes, categories, and other variables are generated. The interpretive goal of the project is to examine some of the conflicting and ambiguous features of dying that emerge in team meetings and that interview respondents describe, and to reveal some of the social and cultural sources of deficient models of care and patient and family suffering so that new models can be proposed.